One of the most importance changes is the expansion of the recommendation for oral blood thinners to include agents other than warfarin for patients with nonvalvular atrial fibrillation who are at acceptably low risk for bleeding complications (options now include dabigatran, apixaban, and rivaroxaban as well as warfarin).

News Around The Globe

Researchers are increasingly recognizing restless genital syndrome as a variant of restless leg syndrome. RGS is a rare disorder that can be a source of distress and disability. In the past, it has been labeled with several different names, including "vulvar dysesthesia" and "persistent genital arousal disorder." In a report published online October 6 in JAMA Neurology, researchers discussed a woman with Parkinson's disease (PD) and disabling genital discomfort who had a dramatic response to the dopamine agonist pramipexole (0.25 mg at night). The patient described a sensation of "congestion," itching, and "growing" of pelvic organs, symptoms that were triggered by sitting or lying down. There was no restlessness in her legs. The patient had been taking levodopa/carbidopa for about 3 years. Gabapentin, codeine, and opiates may also be effective in treating the symptoms. RLS occurs more often in patients with PD than in the general public, although because they receive dopamine replacement therapy, their symptoms may not be noticed. The authors concluded that RGS should be considered a phenotype of RLS, as should restless bladder and restless abdomen.

Patients with diabetes do not need to fast for lipid tests, suggests a review article published in the November issue of Postgraduate Medicine. The authors quote recent evidence suggesting there is little difference in LDL-cholesterol levels between tests done in fasted vs. nonfasted states and that the two testing modes equally predict mortality.

In vitro fertilization (IVF) pregnancy rates tend to be lower when the man has been exposed to high levels of the environmental pollutant bisphenol A (BPA), suggests new research presented at the American Society for Reproductive Medicine (ASRM) 2014 Annual Meeting.

Intensive behavioral counseling works well for clinically significant weight loss, reports a systematic review of patients who received counseling for at least 3 months receiving diet, exercise, and behavioral therapy. Specific calorie targets and greater numbers of counseling sessions were linked with greater weight loss. The review is published in the November 5 issue of JAMA.

Acid suppressors are associated with more severe community-acquired pneumonia; however, comorbidities like diabetes and chronic obstructive pulmonary disease (COPD) could have played a role in the results, suggests a new study presented at CHEST 2014.

Dr KK Spiritual Blog

Dealing with a Muslim patient?

Islam is based on the teachings of Paigambar Mohammad. Muslims believe in only one God ‘Allah’ who is most powerful. As in Christianity, after death, the soul is judged by Allah and remains either in heaven or hell.

Muslims believe in message from Quran, prayers, rituals and fasting. As per Islam, suffering is caused because of alienation from the will of Allah and resolved by total surrender to His will, as embodied in Quran.

Muslims believe in 5 pillars of Islam and they are testimony of faith, daily ritual prayers, obligatory giving, fasting and pilgrimage to Mecca, designated as the holy city of Islam by Mohammed Saheb.

Even when a patient is ill, he is still required to perform five times daily prayers by bowing as much as his condition allows. When he gets too ill for physical exercise, he is expected to perform prayer in the best position allowed by his condition.

For Muslims, Mosque is the place for worship, meditation and learning. Mosque is also a place for Muslims to share a sense of community with their fellow Muslims. They do not eat pork and do not consume alcohol. Muslims are also required to wash specific parts of the body before every prayer.

In Islam creation, death and resurrection are linked. Life is viewed as time of preparation for the soul to pass into life after death.

The relatives of Muslims who are dying usually want the dying patient to lie with face towards Mecca, if the direction is not known, then the head is to be turned round. Dying patient’s family members pray and read verses from Quran and encourage the patient to repeat the statement for their faith. In Islam, body is not considered dead until it has become cold.

At the time of death, eyelids are closed and jaw is closed. Within 24 hours of the death, body is required to be ritually washed, anointed, prayed over and buried. The body is buried in such a manner that the head is directed towards the city of Mecca.

Physician assisted suicide is prohibited in Islam. Muslims believe that assisting in burial service as a meritorious act whether or not the deceased person is known. Many services may be held at same time at different places which are considered spiritually beneficial for the dead and the people who participate in the services.

Islam does not permit to cause hurt to patient with equipment. In Islam, burial should take place within 24 hours of death.

National Program for early detection of atrial fibrillation and prevention of stroke

Afib Screening: Atrial fibrillation is an ongoing new epidemic of the society. It currently affects 3 to 6 million of Americans and 1.27 million Indians and that number is expected to rise. And it is often silent until discovered either incidentally or after a stroke.

Recently, the EMBRACE and CRYSTAL-AF trials looked at the use of continuous long-term cardiac monitoring in individuals with recent cryptogenic cerebrovascular accident. Both trials found an increase in the detection of atrial fibrillation.

Inspirational Story

Poison

A long time ago, a girl named Li-Li got married and went to live with her husband and mother-in-law. In a very short time, Li-Li found that she couldn't get along with her mother-in-law at all. Their personalities were very different, and Li-Li was angered by many of her mother-in-law's habits. In addition, she criticized Li-Li constantly.

Days passed days, and weeks passed weeks. Li-Li and her mother-in-law never stopped arguing and fighting. But what made the situation even worse was that, according to ancient Chinese tradition, Li-Li had to bow to her mother-in-law and obey her every wish. All the anger and unhappiness in the house was causing the poor husband great distress.

Finally, Li-Li could not stand her mother-in-law's bad temper and dictatorship any longer, and she decided to do something about it.

Li-Li went to see her father's good friend, Mr. Huang, who sold herbs. She told him the situation and asked if he would give her some poison so that she could solve the problem once and for all. Mr. Huang thought for awhile, and finally said, Li-Li, I will help you solve your problem, but you must listen to me and obey what I tell you. Li-Li said, "Yes, Mr. Huang, I will do whatever you tell me to do."

Mr. Huang went into the back room, and returned in a few minutes with a package of herbs. He told Li-Li, "You can't use a quick-acting poison to get rid of your mother-in-law, because that would cause people to become suspicious. Therefore, I have given you a number of herbs that will slowly build up poison in her body. Every other day prepare some pork or chicken and put a little of these herbs in her serving. Now, in order to make sure that nobody suspects you when she dies, you must be very careful to act very friendly towards her. Don't argue with her, obey her every wish, and treat her like a queen." Li-Li was so happy. She thanked Mr. Huang and hurried home to start her plot of murdering her mother-in-law.

Weeks went by, and months went by, and every other day, Li-Li served the specially treated food to her mother-in-law. She remembered what Mr. Huang had said about avoiding suspicion, so she controlled her temper, obeyed her mother-in-law, and treated her like her own mother. After six months had passed, the whole household had changed. Li-Li had practiced controlling her temper so much that she found that she almost never got mad or upset. She hadn't had an argument in six months with her mother-in-law, who now seemed much kinder and easier to get along with.

The mother-in-law's attitude toward Li-Li changed, and she began to love Li-Li like her own daughter. She kept telling friends and relatives that Li-Li was the best daughter-in-law one could ever find. Li-Li and her mother-in-law were now treating each other like a real mother and daughter. Li-Li's husband was very happy to see what was happening.

One day, Li-Li came to see Mr. Huang and asked for his help again. She said, "Dear Mr. Huang, please help me to keep the poison from killing my mother-in-law! She's changed into such a nice woman, and I love her like my own mother. I do not want her to die because of the poison I gave her."

Mr. Huang smiled and nodded his head. "Li-Li, there's nothing to worry about. I never gave you any poison. The herbs I gave you were vitamins to improve her health. The only poison was in your mind and your attitude toward her, but that has been all washed away by the love which you gave to her."

Have you ever realized that how you treat others is exactly how they will treat you? In China it is said: The person who loves others will also be loved. THE GOLDEN RULE.

Rabies News (Dr A K Gupta)

What are the limitations of polyclonal serum (RIG)?

Difficulties associated with the use of Polyclonal Serum (RIG) samples might consist of:

Batch–to–batch variation

Risk related to the use of human blood products. Because HRIG preparations are of human origin, they need to be treated to minimize the risk of transmission of infectious agents.

Difficulties in finding immune donors during sudden mass exposures might lead to a low availability of RIG.

Because of discontinued ERIG production by international manufacturers, supply of ERIG relies on regional production.

The use of ERIG has raised ethical issues and has been condemned by animal protection groups.

Cardiology eMedinewS

Defibrillator-implantation procedures are associated with worse in-hospital outcomes when they are performed on weekends and afternoons than on weekdays and mornings, reports a new study published in the American Heart Journal. Researchers noted that those implanted in the afternoon or evening compared with the morning had a significantly greater risk of experiencing in-hospital complications (major - lead dislodgment, venous dissection, MI, or need for surgery; minor - hematoma or drug reactions).

Patients with chest pain but without angiographic signs of abnormal coronary arteries were more likely to suffer from psychological symptoms of anxiety, somatoform disorder, and hypochondria than the general population, suggested a study published online November 3 in Open Heart.

Pediatrics eMedinewS

A retrospective analysis of data on children with hepatoblastoma has suggested that many of these are resectable after only two cycles of chemotherapy and a small proportion of tumors that were still unresectable after two rounds became resectable after a further two cycles of chemotherapy. The data is published online in the British Journal of Surgery. The study thus suggests that chemotherapy could be reduced in up to 65% of children with hepatoblastomas compared with the current standard of care.

Children conceived through in vitro fertilization (IVF), especially those resulting from fresh embryo transfers, tend to have an increased risk for thyroid dysfunction, suggests new research presented at the American Society for Reproductive Medicine 2014 Annual Meeting.

Quote of the Day

A successful man is one who can lay a firm foundation with the bricks others have thrown at him. David Brinkley

Wellness Blog

Sangat and Smoking

Sewa, Simran and Sangat are the three principles of life as per the most Vedic literature. Even Adi Shankaracharya described Sangat as the main force for living a spiritual life.

Sangat is the company of people you live with. Living in the company of good people makes one good and the reverse is also true.

The same is now being proved in the allopathic context. A new research published in the New England Journal of Medicine has shown that when one person quits smoking, than others are likely to follow. One person quitting can cause a ripple effect, making others more likely to kick the habit.

If your friend kicks the habit, it's about 36 percent less likely that you'll be smoking.

When a sibling gives up cigarettes, your risk of smoking decreases by 25 percent.

It drops by 34 percent if a coworker in a small office quits smoking. It's sort of like watching dominoes. If one falls, it very quickly causes others to fall.

We should treat people in groups, rather than as individuals. Friends and family need to be involved. If you want to quit, try to get close friends and family to quit as well.

Quitting smoking may have the side benefit of improving social well-being, just as it improves physical health.

ePress Release

Winter Asthma

Any breathlessness after the age of 40, appearing for the first time in winter, is cardiac asthma unless proved otherwise. Such patients should immediately get their blood pressure checked, which if found high needs immediate medical attention. First-onset breathlessness can also be an indication of angina or heart attack, said Padma Shri, Dr. B C Roy National Awardee & DST National Science Communication Awardee, Dr. K K Aggarwal, President Heart Care Foundation of India and Sr National Vice President Indian Medical Association. However, winter asthma or acute exacerbation of winter COPD (chronic bronchitis) is more common.

Asthma is reversible airway obstruction and COPD is irreversible airway obstruction. Sudden exposure to cold, humidity, pollution at lower levels in atmosphere can precipitate asthma in susceptible individuals. Winter is the time to increase the dose of asthma medicines.

If a person can speak a full sentence, the asthma attack is mild; if a person speaks broken sentences, the asthma attack is moderate and if the person is able to speak only words then the asthma attack is severe. Severe attack of asthma needs immediate hospitalization.

An attack of asthma is due to inflammation, narrowing and collection of fluid in the windpipe and needs medicines to widen the windpipe and reduce the inflammation.

The need of asthma medicines can be intermittent and/or permanent. The ‘Formula of ‘2’ becomes handy in such situations. A person who consumes more than two canisters of inhalers in a year or consumes asthma medicines more than twice in the night time in a month or more than twice in a day in a week, then he or she needs continuous asthma and anti inflammatory medicines. Inhalers are the best choices.

The Sameer Malik Heart Care Foundation Fund is a one of its kind initiative by the Heart Care Foundation of India instituted in memory of Sameer Malik to ensure that no person dies of a heart disease because they cannot afford treatment. Any person can apply for the financial and technical assistance provided by the fund by calling on its helpline number +91 9958771177 or by filling the online form.

Situation: An elderly with NSAID–induced GI bleed came to ICU.Dr Bad: Don’t worry it carries no mortality.Dr Good: It can carry high mortality.Lesson: Elderly users of aspirin and NSAIDs, especially women, are at increased risk of fatal peptic ulcer complications.

Make Sure

Situation: A patient with suspected pneumonia and normal x–ray died 12 hours after admission.Reaction: Oh my God! Why were antibiotics not started?Lesson: Make sure that all patients with suspected pneumonia are given antibiotics at the first suspicion as x–ray can be normal in the first 24 hours.

eMedinewS Humor

That Darned Cat

A man absolutely hated his wife's cat and decided to get rid of him one day by driving him 20 blocks from his home and leaving him at the park. As he was getting home, the cat was walking up the driveway.

The next day he decided to drive the cat 40 blocks away. He put the beast out and headed home. Driving back up his driveway, there was the cat!

He kept taking the cat further and further and the cat would always beat him home. At last he decided to drive a few miles away, turn right, then left, past the bridge, then right again and another right until he reached what he thought was a safe distance from his home and left the cat there.

Hours later the man calls home to his wife: "Jen, is the cat there?"

"Yes", the wife answers, "why do you ask?"

Frustrated, the man answered, "Put that darned cat on the phone. I'm lost and need directions!"

Twitter of the Day

Dr KK Aggarwal: AC should be lower than 90cm in man 80cm in womenDr Deepak Chopra: Miracles defy science; they don’t contradict it. Find out more about my new book The Future of God at

eMedi Quiz

The cells belonging to the following type of epithelium are provided with extra reserve of cell membrane:

Yesterday’s Mind Teaser: A 30-year-old man came to the outpatient department because he had suddenly developed double vision. On examination it was found that his right eye, when at rest, was turned medially. The most likely anatomical structures involved are:

Choosing the best option in the judgment of the doctor is not medical negligence

In the case of Charan Singh vs Healing Touch Hospital And Ors on 24 April, 2003 [III(2003) CPJ 62 (NC)], the National Consumer Disputes Redressal Commission observed “it is a settled law when two choices are available, exercise of one, which is the best in the judgment of the doctor and anything else is available to contradict this, doctor in such circumstances cannot be held negligent.

Hi Dear Dr KK I like the diabetes update the most in this news letter. Thanks. Dr Vinod Agarwal